Provider Demographics
NPI:1275192189
Name:BERRY, WILLIAM PAUL (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PAUL
Last Name:BERRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 TRACY DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4907
Mailing Address - Country:US
Mailing Address - Phone:406-443-2780
Mailing Address - Fax:
Practice Address - Street 1:2480 TRACY DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4907
Practice Address - Country:US
Practice Address - Phone:406-443-2780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT173471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice